SEXUAL MISCONDUCT REPORTING FORM
DO NOT USE THIS FORM TO REPORT AN IMMEDIATE OR ONGOING THREAT. CALL 112, THEN CALL RECEPTION TO BE CONNECTED TO THE VICE PRESIDENT OF STUDENT LIFE

Use this form if you are a student, employee, faculty, or other member of the LCC community wishing to report an incident of Sexual Misconduct that you personally endured or witnessed.

What is sexual misconduct?
Sexual misconduct includes: rape, sexual assault, sexual coercion, sexual harassment, domestic and dating violence,
stalking, and all other forms of sexual misconduct.

Will the information provided be kept private? Yes. The information provided in this form will only be shared with those individuals who are involved in the review, investigation, or resolution of the report.

Is the information on this form confidential? No. Confidentiality means that information provided by an individual
cannot be revealed to anyone else without the express permission of the individual. However, a person who
reports Sexual Misconduct may request that his or her identity be kept confidential, and such a request will
be considered in determining an appropriate response.

Can I use this form to report anonymously? Yes. Just leave your name and last name blank. Anonymous reports will be investigated, however, our response may be limited depending on the information provided.

What happens after this form is submitted? Upon receipt, appropriate officials will review the information
provided and conduct a preliminary inquiry into the reported allegations. The person(s) identified in this form may be
contacted to discuss the information provided and determine appropriate next steps.
Your name
Your last name
LCC email
Phone number
Are you? *
If you are a Third Party, does the Victim know you are making this report? *
Your status *
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